Chromaffin vesicles (CV) are highly sophisticated secretory organelles synthesized in adrenal medullary chromaffin cells. They contain a complex mixture of structural proteins, catecholamine neurotransmitters, peptide hormones, and the relative processing enzymes, as well as protease inhibitors. In addition, CV store ATP, ascorbic acid, and calcium. During the last decades, extensive studies have contributed to increase our understanding of the molecular composition of CV. Yet, the recent development of biochemical and imaging procedures has greatly increased the list of CV-soluble constituents and opened new horizons as to the complexity of CV involvement in acute stress responses. Thus, a coherent picture of CV molecular composition is still to be drawn. This review article will provide a detailed account of the content of CV soluble molecules as it emerges from the most recent analytical studies. Moreover, this review article will attempt at focussing on the physiological and pathophysiological implications of the products released by CV. Anat Rec, 291:1587–1602, 2008. © 2008 Wiley-Liss, Inc.